FIND A COVID-19 VACCINE NEAR YOU
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In general, how would you describe your own health? Is it excellent, very good, good, fair or poor? ExcellentVery goodGoodFairPoorDon't knowRefused Has a doctor or nurse ever talked to you about diet, exercise or nutrition? YesNoRefused If yes: Was that in the past year, between one and three years ago, or more than three years ago? In the past yearBetween one and three yearsMore than three years agoDon't knowRefused Have you ever lost more than 5 pounds through some kind of special effort on your part, such as a special diet or exercise program? YesNoNot sureRefused If yes: Did you keep that weight off for at least a year? YesNoNot sureRefused When is the last time you weighed yourself? Would you say it was: TodayWithin the last weekWithin the last monthMore than a month agoDon't knowRefused I’m going to name some things that some people say are important for good health and nutrition. For each, tell me whether it is very important, somewhat important, not very important or not at all important to you. Reading nutrition labels in the grocery store Very importantSomewhat importantNot very importantNot at all importantDon't know/Refused Eating breakfast Very importantSomewhat importantNot very importantNot at all importantDon't know/Refused Getting at least 20 minutes of exercise at least every other day of the week Very importantSomewhat importantNot very importantNot at all importantDon't know/Refused Eating fruits and vegetables Very importantSomewhat importantNot very importantNot at all importantDon't know/Refused Arranging my schedule to make good nutrition possible Very importantSomewhat importantNot very importantNot at all importantDon't know/Refused Do you work for pay outside of the home? YesNoRefused Asked of those that work for pay outside the home: Is a cafeteria available at your workplace? YesNoRefused If yes: How would you describe the food in your workplace cafeteria? Would you say it is: Very nutritiousSomewhat nutritiousNot very nutritiousNot at all nutritiousDon't know/Refused Asked of those that work for pay outside the home: Are vending machines available at your workplace?YesNoRefused If yes: Do the vending machines at your workplace offer nutritious snacks or not?YesNoDon't knowRefused Asked of those that work for pay outside the home: Is there an exercise facility available at your workplace?YesNoRefused If yes: Have you ever made use of the exercise facility at your workplace?YesNoRefused If use exercise facility at work: How often would you say you use the facility?DailyOnce a weekOnce or twice a monthOnce in a whileRefused Asked of those that work for pay outside the home: In general would you say that your employer is making an effort to assist you in being healthy or is that not a concern to your employer?Assisting in being healthyNot a concernDon't knowRefused Now thinking about recreational options in your community. For each of the following, tell me whether your community has an adequate supply of this resource or not?YesNoRefused Biking pathsYesNoRefused Dog walking trailsYesNoRefused And for each of those resources, do you use them often, once in a while, or not at all? Walking pathsOftenOnce in a whileNot at allRefused Biking pathsOftenOnce in a whileNot at allRefused Dog walking trailsOftenOnce in a whileNot at allRefused Do you have children now in the local public schools?YesNoRefused Asked of those with children in public schools: Based on what you know about the meals served at the schools, would you say that the food is:Very nutritiousAcceptableNot nutritious enoughDon't know Asked of those with children in public schools: And how about the amount of physical exercise that the school promotes, do you believe children get plenty of exercise during the school day, some exercise, or not enough exercise?PlentyNot enoughDon't know Thinking now about your community as a whole, that is, including schools and other institutions, do you think the community does an excellent job of promoting healthy lifestyles, a good job, a fair job or a poor job of promoting healthy lifestyles?ExcellentGoodFairPoorDon't knowRefused Before we finish, I’m going to read you a few suggestions that some people have made that they believe would encourage more people to live a healthy lifestyle. For each, tell me first whether or not you think it is a good idea, and secondly if you do this Offer school facilities to the public for exercise and recreationGood ideaBad ideaDon't know/Refused If good idea: Using school facilities for exercise and recreationWould participate inWould not participate inDon't know/Refused Conduct free public workshops on nutritionGood ideaBad ideaDon't know/Refused If good idea: Attend free public workshops on nutritionWould participate inWould not participate inDon't know/Refused Conduct free public workshops on fitnessGood ideaBad ideaDon't know/Refused If good idea: Attend free public workshops on fitnessWould participate inWould not participate inDon't know/Refused Offer public inexpensive weight loss programsGood ideaBad ideaDon't know/Refused If good idea: Attend public inexpensive weight loss programsGood ideaBad ideaDon't know/Refused Encourage health oriented restaurants to open in the areaGood ideaBad ideaDon't know/Refused If good idea: Eat at health oriented restaurants in the areaWould participate inWould not participate inDon't know/Refused Would you support a 1% sales tax that some have proposed be applied to junk food? Do you support that idea, oppose it or would you need more information in order to decide?SupportOpposeNeed more informationRefused
